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How Effective Is Hormone Therapy For Prostate Cancer

Rationales For Combined Treatment Adtebrt

Intermittent Hormone Therapy for Prostate Cancer 101 | Ask a Prostate Expert, Mark Scholz, MD

In an early work, Huggins and Hodges stated that male hormones promote the growth of both prostate gland and cancer cells.10 However, recently it has been recognized that the relationship between serum levels of testosterone and PC progression is not that straightforward. Very low concentrations of serum testosterone are enough to fulfill its activating role on the PC cell through the so-called aberrant androgen-signaling pathways.11,12 Moreover, there is an evidence for a significant increase in local synthesis of testosterone within prostate stimulated by castrate levels of serum hormone.13 Even so, the incomplete eradication of testosterone with surgical or pharmacological castration has proved to improve the results of RT, and multiple studies looked into the possible mechanism and character of that interaction.

Intermittent Hormonal Therapy For Locally Advanced Prostate Cancer

Intermittent hormonal therapy is where you stop taking the drugs and after a while start taking them again. This may be an option for locally-advanced prostate cancer. It gives you a break from the side effects of hormonal therapy.

Intermittent hormonal therapy is not suitable for everyone and should only be done on your doctors advice. Your doctor can explain more about this. They usually measure your PSA level using the PSA test every 3 months. If it goes up to a certain level or you get symptoms, your doctor will advise you to start hormonal therapy again.

Hormone Therapy In Older Patients

The backbone of prostate cancer treatment is hormonal therapy, which aims to limit the activation of the androgen receptor with testosterone. This limitation of AR activation may occur through agents that decrease circulating testosterone, such as gonadotropin-releasing hormone agonists or antagonists. The use of these agents also decreases testosterone precursors and other off-target effects of testosterone. Agents such as nonsteroidal anti-androgens block AR activation and yet preserve circulating testosterone levels.

Providers must carefully consider the toxicities of androgen deprivation therapy in a physiologically older population. These patients have less reserve to absorb additional imbalances or conditions that will impact their current steady state. In general, agents that result in a hypogonadal state can lead to toxicities within the following domains: metabolic and body composition sexual health and mood and central nervous system symptoms .

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Will Side Effects Limit What I Can Do

What you are able to do will depend on which side effects you have and how bad they are. Many men are able to work, cook meals, and enjoy their usual daily activities when they have hormone therapy for their prostate cancer. Other men find that they need more rest than before they started hormone therapy so they cant do as much. You should try to keep doing the things you enjoy as long as you don’t get too tired.

Hormone Therapy And Radiation Therapy In Treating Patients With Prostate Cancer

Prostate Cancer
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
First Posted : January 27, 2003Results First Posted : October 31, 2017Last Update Posted : June 15, 2022

RATIONALE: Hormones can stimulate the growth of prostate cancer cells. Hormone therapy may fight prostate cancer by reducing the production of androgens. Radiation therapy uses high-energy x-rays to damage tumor cells. It is not yet known which regimen of hormone therapy and radiation therapy is more effective for prostate cancer.

PURPOSE: Randomized phase III trial to compare the effectiveness of two different regimens of hormone therapy and radiation therapy in treating patients who have prostate cancer.

Condition or disease
Drug: CasodexDrug: EulexinDrug: LHRH agonistRadiation: radiation therapy Phase 3

OBJECTIVES:

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to prostate-specific antigen level , tumor stage , Gleason score , and prior hormonal therapy . Patients are randomized to one of two treatment arms.

Patients are followed every 3 months for 1 year, every 6 months for 4 years, and then annually thereafter.

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Treating Prostate Cancer That Doesnt Go Away Or Comes Back After Treatment

If your prostate-specific antigen blood level or another test shows that your prostate cancer has not been cured or has come back after the initial treatment, further treatment can often still be helpful. Follow-up treatment will depend on where the cancer is thought to be and what treatment you’ve already had. Imaging tests such as CT, MRI, or bone scans may be done to get a better idea about where the cancer is.

What Is Stereotactic Body Radiation Therapy And What Advantages Does It Offer

Stereotactic body radiation therapy, or SBRT, involves the use of sophisticated image guidance that pinpoints the exact three-dimensional location of a tumor so the radiation can be more precisely delivered to cancer cells. Traditionally, external beam radiation has been delivered in anywhere from 45-48 sessions over multiple weeks. But large, randomized studies have shown that shorter courses of radiation are just as safe and effective. Therefore, at MSK, we have shortened all our radiation courses.

There is increasing interest in giving this radiation in very short courses of treatment using intense radiation doses, called hypofractionated radiation therapy. Many of the people we care for have a type of radiation therapy called MSK PreciseTM. This is a hypofractionated form of SBRT that can be given in five sessions. MSK has been doing this for the past 20 years, and the results in the several hundred people whove been treated have been excellent so far. The treatment is very well tolerated and quite effective

Because of its superior precision, MSK Precise can have fewer side effects than more conventional radiation techniques, with extremely low rates of incontinence and rectal problems. The sexual side effects are low, similar to what is experienced with more extended external radiation techniques. And of course, its much more convenient for patients.

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Your Cancer Care Team

People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.

The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.

Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.

When deciding what treatment is best for you, your doctors will consider:

  • the type and size of the cancer
  • what grade it is
  • whether the cancer has spread to other parts of your body

Survival For All Stages Of Prostate Cancer

Hormone Therapy & Advanced Therapies for Prostate Cancer, Celestia Higano, MD | 2021 Mid-Year Update

Generally for men with prostate cancer in England:

  • more than 95 out of 100 will survive their cancer for 1 year or more
  • more than 85 out of 100 will survive their cancer for 5 years or more
  • almost 80 out of 100 will survive their cancer for 10 years or more

Survival for prostate cancer is also reported in Scotland and Northern Ireland. But it is difficult to compare survival between these countries because of differences in the way the information is collected.

Cancer survival by stage at diagnosis for England, 2019Office for National Statistics

These statistics are for net survival. Net survival estimates the number of people who survive their cancer rather than calculating the number of people diagnosed with cancer who are still alive. In other words, it is the survival of cancer patients after taking into account the background mortality that they would have experienced if they had not had cancer.

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Vasomotor Symptoms Hot Flashes

The so-called hot flashes or, more precisely, vasomotor flushings are a common and well-described treatment toxicity in men undergoing androgen ablation and are one of the most frequently reported adverse consequences of ADT. Spetz et al performed a prospective analysis comparing the incidence of hot flashes in men receiving CAB to that in men receiving estrogen therapy for treatment of PC.52 In this study, in 915 patients with metastatic disease, 458 were treated with polyestradiol phosphate and 457 patients received CAB. Of men receiving CAB, 74.3% reported hot flashes compared to 30.1% in men receiving estrogen therapy . Further, a significantly greater percentage of men treated with CAB were greatly distressed by the hot flashes and reported at least 4 hot flashes per day . ADT-associated vasomotor flushing remains a common complaint reported by men receiving this therapy and is reported in up to 80% of men receiving ADT. Interestingly, megestrol acetate has been demonstrated to reduce hot flash symptoms by up to 85%. On the other hand, chills, weight gain, and carpal tunnel-like pain are the reported side effects of megestrol acetate.53

How Long Does Hormone Therapy Work To Stop Cancer Progression

On average, hormone therapy can stop cancer progression for 1-2 years before the prostate cancer becomes resistant. Hormone therapy can stop working over time as the prostate cancer begins to grow again .

When this occurs, doctors may offer other therapies. Since they cant predict how long hormone therapy will work, they may perform regular blood tests to check PSA and testosterone levels. If PSA levels start to increase and testosterone levels are low, these may be signs that the cancer has started to grow again.

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What Types Of Hormone Therapy Are Used For Prostate Cancer

Hormone therapy for prostate cancer can block the production or use of androgens . Currently available treatments can do so in several ways:

  • reducing androgen production by the testicles
  • blocking the action of androgens throughout the body
  • block androgen production throughout the body

Androgen production in men. Drawing shows that testosterone production is regulated by luteinizing hormone and luteinizing hormone-releasing hormone . The hypothalamus releases LHRH, which stimulates the release of LH from the pituitary gland. LH acts on specific cells in the testes to produce the majority of testosterone in the body. Most of the remaining androgens are produced by the adrenal glands. Androgens are taken up by prostate cells, where they either bind to the androgen receptor directly or are converted to dihydrotestosterone , which has a greater binding affinity for the androgen receptor than testosterone.

Treatments that reduce androgen production by the testicles are the most commonly used hormone therapies for prostate cancer and the first type of hormone therapy that most men with prostate cancer receive. This form of hormone therapy includes:

Treatments that block the action of androgens in the body are typically used when ADT stops working. Such treatments include:

Treatments that block the production of androgens throughout the body include:

Heterogeneity Of Castration Resistance Prostate Cancer

Treating Locally Advanced Prostate Cancer

Even though the AR plays a major role in the progression to CRPC, alternative pathways can have a role in stimulating prostate cancer cells, confirming the cellular heterogeneity in prostate cancer .

Prostate cancer cells can develop alternative AR independent molecular pathways for survival that bypass AR activation, including cancer stem cells, receptor tyrosine kinases and neuroendocrine differentiation . A potential mechanism for survival in the castrate environment is the presence of prostate cancer stem cells that continually supply the cancer cell population, despite therapy. These cells are not affected by ADT and can differentiate into androgen dependent and independent cells, leading to a heterogeneous phenotype of AR .

Activation of the PI3 kinase signaling pathway is critical for the survival of prostate cancer cells. PTEN is a tumor suppressor and has lipid phosphatase activity that metabolizes PIP3 . The PTEN function is expressed primarily through negative regulation of the PI3K/Akt pathway. PTEN is inactivated in several types of cancers, including prostate cancer. Loss of PTEN function in prostate cancer can occur through several mechanisms, including deletion, mutation and methylation. These events can cause tumor cell survival through selective pressure caused by ADT .

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Advanced Prostate Cancer Life Expectancy And Prognosis

Typically, each stage of prostate cancer has different prognosis. In general, the advanced stages of the disease are much more difficult to treat than when the disease is still at early stage not yet spread. What are factors that affect the outlook and life expectancy of patient? The following are some statistics for each stage of this disease.

You might also like to know more about how fast prostate cancer spreads and what are the most common sites /organs of the body for the metastasis of this cancer in this section, before continuing

One thing you need to clearly understand that there is no any statistic that can be detail enough to tell you about what will happen. In other words, this statistic is only purposed for general information! In fact, each case of cancer is unique. So, there is always a chance and a hope for anyone who diagnosed with cancer.

Advanced prostate cancer symptoms

The symptoms of the disease are more likely to occur when the disease at advanced stage. This is the most challenging for doctors, because the early warning signs that are more likely to not occur will increase the number of patients diagnosed with the disease at later stages.

Once the cancerous tumor is bigger in size and also spreads to nearby sites or even other distinct organs of the body, there will be more complications that can be generated. These may include:

Understanding n-years survival statistics

The major factors that affect the outlook of patients

Role Of Hormonal Therapy For High

In contrast to the many efforts to develop better treatment regimens for radiotherapy with hormonal therapy, there have been few clinical trials investigating the effectiveness of neoadjuvant and/or adjuvant hormonal therapy with radical prostatectomy . One reason for this is that early studies of neoadjuvant hormonal therapy did not confirm the improvement of overall survival despite improvements in the pathological findings. In addition, surgeons may have less interest in medical treatments, such as hormonal therapy. However, surgeons should consider the best methods for improving the results in cases of high-risk prostate cancer, because recent reports have indicated the superiority of radiotherapy for high-risk prostate cancer compared with radical prostatectomy . Recently Dorff et al. reported that 2 years of adjuvant androgen deprivation therapy after radical prostatectomy resulted in an extremely low rate of disease recurrence and prostate cancer-specific death for high-risk patients in the SWOG S9921 Study .

Finally, it should be stressed that it may be possible to eradicate prostate cancer death even in the high-risk or locally advanced prostate cancer with appropriate use of hormonal therapy in combination with radiotherapy or radical prostatectomy. Therefore, further well-designed clinical trials are required.

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Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. This condition causes pain in the lower back and groin area, and may cause urinary retention. Symptoms include leaking and discomfort. In severe cases, a catheter may be required to relieve the symptoms. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. If these do not work, your symptoms could progress and become chronic.

An acute bacterial infection can cause a burning sensation. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. The symptoms of acute bacterial prostatitis are similar to those of CPPS. Patients may experience a fever or chills as a result of the infection.

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When Cancer Fights Back

Hormone Therapy for Prostate Cancer

Hormone therapy will likely shrink your tumors, ease your symptoms, and help you live longer. However, these treatments do not cure prostate cancer.

After a whiletypically one to three years after beginning hormone therapyyour cancer will become resistant to this treatment. Although your androgen levels remain low, your doctor will detect an increase in your levels of prostate-specific antigen , a chemical in your blood that identifies prostate cancer. Or, he or she may see new tumors on an imaging test.

Doctors aren’t sure why the cancer becomes resistant to hormone therapy. They believe cancer cells mutate so they no longer require androgens to grow. When that happens, you’re said to have castration-resistant prostate cancer.

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Checking Your Hormone Therapy Is Working

You have regular blood tests to check the level of a protein called prostate specific antigen . PSA is a protein made by both normal and cancerous prostate cells. It is in the blood in small amounts in all men, unless you have had the prostate gland completely removed.

While the hormone therapy is working, the level of PSA should stay stable or may go down. But if prostate cancer starts to grow and develop, the level of PSA may go up. This is hormone resistant prostate cancer or castrate resistant prostate cancer. Then your doctor may need to change your treatment. They will discuss this with you

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Gross Findings Of Hormonal Effects On Bph And Prostate Cancer

Grossly, prostates from patients treated with luteinizing hormone-releasing hormone analogues or antiandrogens are small, and benign prostatic hypertrophy and carcinoma can be more difficult to identify macroscopically, compared with untreated glands. Treated glands are shrunken and have a rubbery to soft consistency.

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Hormone Therapy And Prostate Cancer

Prostate cancer is fueled by testosterone, a hormone produced in the testicles. The aim of HT is to interfere with either testosterone production or cancer cells’ ability to use testosterone. Medical evidence tells us that eliminating or substantially reducing testosterone production has a significant impact on controlling progression of the disease and may even halt progression. Testosterone is one of several hormones called androgens that are linked to sexual health and other processes in the body. This is why HT is often referred to as androgen deprivation therapy .

To be clear, this is not the “hormone therapy” of which you often hear. Women get “hormone therapy” to supplement waning estrogen levels, and older men without prostate cancer may get “hormone therapy” that administers additional testosterone. The “hormone therapy” we are talking about for men with prostate cancer is more accurately described as androgyn deprivation therapy . It is given to lower testosterone levels.

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